There has been hesitation in accepting the routine use of echocardiography in patients with hypertension. The concept of "limited" or "focused" echocardiography has been introduced but incompletely evaluated. In this prospective observational cohort study, 100 consecutive hypertensive adults underwent comprehensive two-dimensional echocardiography and Doppler assessment regardless of referral question. Patients were categorized on the basis of echocardiographic referral questions into two groups: (1) determination of left ventricular mass only (limited echocardiography) and (2) determination of left ventricular mass and associated cardiac problems. In group 1, missed diagnoses were rare (5%). Additional, clinically relevant information was provided by comprehensive echocardiography in 9% of patients. Doppler echocardiography did not provide any additional useful information in group 1 but was useful in group 2. In both groups, echocardiography affected clinical management. In patients referred for determination of left ventricular mass only, the equivalent of limited echocardiography, missed diagnoses are rare. Additional, clinically relevant information is provided in only a small number of patients by comprehensive two-dimensional echocardiography. Comprehensive two-dimensional echocardiography, including Doppler echocardiography, was useful in selected patients referred with hypertension and other cardiac problems and should be part of the echocardiographic assessment of such patients. With careful selection of hypertensive patients, limited echocardiography can be a cost-effective strategy.